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1-Main causes of foot pain in cyclists? 
The demands from cycling place a very different set of forces acting on a foot compared with land based activities such as running. 
The underlying foot structure and movement is still relevant in part and we will come back to that but there are key factors that contribute to foot related symptoms. 
 
Shoe Fit. 
 
The cycling industry have worked hard at developing a cycle shoe that will deliver power to the bike with innovative materials that are stiff under the foot and are lightweight so as not to add that dreaded weight that we have to carry up a climb. 
 
There are multiple cleat options that ensure that we are able to remain engaged with the pedal on both the downstroke and on the upstroke and where the cleat system is fitted into the outsole has generally improved although some companies still design a cleat plate that interferes with the internal part of the shoe which has the potential to create a poor contact point with the under surface of the foot and therefore increase pressure in that area. 
This is a very simple issue that can be avoided by running your hand into the front part of the shoe and feeling for any lumps and bumps that might be a potential area of irritation for you on a long ride. If you feel they are noticeable at this point then you can be sure that it will be noticeable out on the bike. 
 
Last Fitting. 
 
The absolute key to improving your chance of a comfortable ride related to foot pain is the last fitting of your cycle shoe.  
 
One of the commonest complaints I see with my cycling patients is intermittent or at times consistent foot numbness. The main driving external force for this is a shoe that is too tight. 
 
In the footwear industry this is referred to as toe box volume and toe box depth and there are still many cycle shoe companies that are producing shoes that do no reflect the foot dimensions of the general public. 
 
There is a small group of cyclists where these symptoms start to affect the foot outside of cycling and this represents a condition referred to as a neuroma. 
 
This is essentially a nerve fibre in the foot which has become inflamed and easily irritated. The main symptoms would include a pins and needles sensation in the foot which may effect some of the toes progressing onto areas of the foot feeling numb. 
 
The are effective treatment options available such as injection, anti inflammatories and footwear / orthotic input and its essential to see a clinician with a special interest in foot problems. 
 
 
Key points to remember; 
 
The foot volume increases as we exercise as the blood flow to the muscles increase. 
 
The foot will be bound relatively firmly inside the shoe for the duration of your ride with occasional coffee stops or toilet breaks so its a reasonably oppressive environment. 
 
Avoid using thick socks to keep the feet warm in the colder months,layering thinner socks has a better insulating effect and will reduce the volume of the foot in the shoe. 
 
Posture. 
 
A cycle fit is an essential feature of minimising the mechanical burden of cycling.  
 
If you have any consistent body symptoms then its advised to have a look at bike fit. The cycle fit specialist will look at your set up of the bike and also look at what positions you are capable of on the bike to see if you work well with a number of factors….bottom line…its critical in minimising injury risk. 
 
You might be wondering what posture has to do with foot pain….a lot. 
 
If you think about your side on profile on the bike there is lot of stress around the low back and pelvis and a reasonable number of cyclists develop foot numbness that is referred from the back as the nerves are compressed at that level. 
 
These symptoms tend to respond to time out of the seat and pressure taken of the back and pelvis. Generally these symptoms will resolve with the periods of time out of the saddle but there are occasions where the symptoms persist after the ride. 
 
What Can I do to minimise the postural problems on the bike? 
 
A bike fit is the obvious first line approach but you also need to consider your flexibility (or lack of!) and strength (or lack of!) around your lower back. 
 
This is where gym or home based strength and length programs are key to comfort on the bike and if performed on a relatively regular basis should minimise this as a contributory factor. 
 
There are some excellent clinicians out there who are skilled in this area and this could be a Physiotherapist / Chiropractor / Osteopath / Performance Coach and its key to do your homework and ensure that they have an active interest in cycling.  
 
Word of mouth recommendations tend to work the best so speak with your cycling buddies, you never know they may have experienced the same issues. 
 
2- What to do about a foot ache post-ride? 
 
The vast majority of foot related symptoms should settle once the ride has ended and we are back in regular footwear. 
 
Foot pain that is still present into the following day needs to be assessed by a clinician with a special interest in foot problems. 
 
3- Issues most common to cyclists (ingrown toenails, athlete's foot, what are the major ones?) 
 
There is no consistent presenting foot problems in cycling per se. 
 
With the increasing participation in triathlon we see a number of running related symptoms affecting time on the bike. 
 
The fact that the foot is often in an enclosed shoe for prolonged periods of time does increase the risk of soft tissue problems such as athletes foot mainly due to the heat generated across the foot / sock /shoe interface which can be added to when wearing shoe covers. 
 
This creates an environment for fungal spores to develop particularly with the multi day sportives. 
 
A number of cyclists may be fair weather riders but the majority will ride in wet weather or at the very least end up caught in a shower and this creates a further risk factor for developing athletes foot due to the moisture content. 
 
Key points to remember. 
 
Take more than one pair of socks for multi day sportives (see video above of Bordeaux to Barcelona in 4 days, long days in the saddle meant kit was key)
 
Try and dry out the cycle shoe after a wet ride. 
 
If you develop an infection treat early with an anti fungal cream and ensure that you continue to use for 7 days post infection settling. 
 
 
4- When should you see a specialist/when should you try new shoes? 
 
Any consistent foot and ankle problem should be assessed with a clinician with a special interest in foot and ankle problems. 
 
The clinician does not necessarily need to be a cyclist but they should have working knowledge of cycling related injuries. 
 
Ensure you purchase the right fit of cycling shoe and discuss the issue of cleats and pedals with your local bike shop as they will have great knowledge of the interaction of the foot with the bike. 
 
The issue of orthotics (insoles / arch supports) in cycling footwear is an emerging area and although the mechanics of the foot do differ from land based activity to time on the bike there are still some considerations to the role of orthotics when cycling. 
 
These needs to be judged on a case by case basis as it should be relative to the problems that the cyclist is experiencing rather than mass provision of insoles for cyclists just because they are available. 
 
If you are based in Birmingham, London, Leamington Spa, Stratford on Avon or Kenilworth there is a clinic local to you. 
 
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